Updated 02 June 2014

Speed of life

Experts believe a quick response to a critical injury is crucial to the patient’s survival – and sometimes such an emergency rescue means having to fly across Africa.

Experts believe a quick response to a critical injury is crucial to the patient’s survival – and sometimes such an emergency rescue means having to fly across Africa.
By DR ANSKE VAN AS for YOU Pulse magazine

It's just after midnight. "Please go to the airport immediately,"
the emergency centre operator says. It’s an all too
familiar telephone call requesting an urgent response.

"What’s the patient’s condition?" I ask automatically.

"Critical following a car accident a few hours ago. Multiple
broken bones and organ damage. A 40-year-old French nurse in
East Africa. She has lost a lot of blood and is on a ventilator to
help her breathe..."

I pull on my flight uniform. On the way to the airport the
emergency centre operator provides more information about the
patient’s condition including her blood pressure, the number of
units of blood she has received and the emergency treatment so far.

I’m put through to the paramedic who’ll be accompanying me
on the emergency flight and we discuss in detail the treatment
we’ll have to administer and the kind of supplies and equipment
we’ll take on board. The weight of the supplies is important
because it affects the weight of the aircraft and therefore the
amount of fuel we’ll need.

Despite the late hour, there’s a buzz of team activity at the
airport. The ground crew is organising clearances, fuelling the
plane and smoothing our way through customs. We check the
weather en route, file the flight plan and make arrangements
for the patient to be admitted to a trauma hospital
in South Africa.

We’ll be using a propeller-driven air ambulance
– the landing strip is too short for a fast-landing
jet aircraft.

The strip also has no landing lights, only weak
oil lamps that a pilot flying a fast-moving jet
would have difficulty spotting.

Touch and go
When we land, the patient’s husband is waiting
for us, having donated blood to his wife in
the meantime. We quickly load the hi-tech medical
equipment into a waiting ambulance and rush to the
hospital through the humid East African night.

The patient is critical and bleeding profusely.
The hospital’s Russian surgeon saves her life
by removing her badly bleeding right kidney
– and this in a hospital that doesn’t even
have X-ray facilities. In addition to multiple
broken bones, the patient has a torn liver, spleen and pancreas,
and both her lungs have collapsed.

The paramedic and I work together as one: airway, breathing,
circulation, units of blood and resuscitation fluids. We intubate
the lungs, splint the breaks and immobilise her body. We handle
the patient as if she has a broken neck or back, because without
X-rays we can’t be certain. All the emergency treatment is carefully
documented; if it’s not documented it wasn’t done.

We stabilise the patient to stop her condition deteriorating and
prepare her for the air-pressure variations during the flight back
to South Africa, then we transfer her to the aircraft. During the
flight we monitor every heartbeat and every breath. Intravenous
medication is administered continuously. The interior of the
aircraft has become an intensive care unit.

A team of seven specialist doctors and nurses are waiting for us
when we arrive at the trauma hospital in Johannesburg. A counsellor
takes the patient’s husband aside while I brief the hospital team.

Good news
Sometimes patients are too ill to fly and there’s nothing you can
do to save their life. In this case, however, I receive a heart-warming
call two months after the incident.

The former patient would like me to meet her and her husband for coffee. For a moment in the coffee shop we sit in awed silence at the extraordinary
second chance this woman has received.

After five years as an air ambulance doctor I have
exchanged that adrenaline-driven occupation for a
more predictable one with more regular hours. My
colleagues warned me that adapting to treating
patients who are not critically ill could be quite
a challenge.

I’ve learnt, however, that for a suburban
mother with a feverish child it’s just as
important to see her child improve –
quickly – as it is for any mother
elsewhere in the world.

I salute every one of my former
air ambulance colleagues and
all medical and non-medical
emergency staff wherever they
work. They have tough, stressful
jobs but they’re passionate about
what they do.

(This is an edited version of a story that originally appeared in YOU Pulse / Huisgenoot-POLS magazine, Winter 2008. Buy the latest copy, on newsstands now, for more fascinating stories from the world of health and wellness.)

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